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Review
. 2021 Nov 3:12:763412.
doi: 10.3389/fimmu.2021.763412. eCollection 2021.

COVID-19 in B Cell-Depleted Patients After Rituximab: A Diagnostic and Therapeutic Challenge

Anna Furlan  1 , Gabriella Forner  2 , Ludovica Cipriani  2 , Elisa Vian  3 , Roberto Rigoli  3 , Filippo Gherlinzoni  1 , Piergiorgio Scotton  2
Affiliations
Review

COVID-19 in B Cell-Depleted Patients After Rituximab: A Diagnostic and Therapeutic Challenge

Anna Furlan et al. Front Immunol. .

Abstract

B cell-targeting strategies such as rituximab are widely used in B cell hematologic malignancies, rheumatologic and musculoskeletal diseases and a variety of autoimmune disorders. The purpose of this paper is to illustrate how exposure to anti-CD20 treatment profoundly affects B cell functions involved in anti-SARS-CoV-2 immunity and significantly impacts on the clinical and serological course of SARS-CoV-2 infection, long term immunity and vaccine responses. The data presented here suggest that the effects of B cell-depleting agents on adaptive immunity should be taken into account for the proper selection and interpretation of SARS-CoV-2 diagnostics and to guide appropriate therapeutic approaches and protective measures. Combination therapeutic strategies including immunotherapy in association with prolonged antiviral treatment may play a decisive role in the setting of B cell immune deficiencies.

Keywords: B cell immunodeficiency; B cell-depletion; COVID-19; SARS-CoV-2; anti-CD20 therapy; anti-SARS-CoV-2 monoclonal antibodies; hyperimmune convalescent plasma; rituximab.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
(A) A potential therapeutic approach to immune compromised B cell-depleted patients with COVID-19 on/after Rituximab therapy. Mild to moderate disease. MoAbs, monoclonal antibodies; CP, convalescent plasma; Ig, Immunoglobulins. (B) A potential therapeutic approach to immunocompromised B cell-depleted patients with COVID-19 on/after Rituximab therapy. Moderate to severe disease. MoAbs, monoclonal antibodies CP, convalescent plasmas; Ig, Immunoglobulins; HF, high flow; suPAR, plasma Soluble Urokinase-Type Plasminogen Activator Receptor. aThe role of anti-inflammatory drugs in B cell-depleted patients with COVID-19 on/after Rituximab may be questionable due to the lower levels of inflammatory biomarkers typically observed in non seroconverters and needs to be assessed in dedicated studies.
See this image and copyright information in PMC

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